Journal article
Clinical features and evolution of bacterial infection-related acute-on-chronic liver failure.
- Wong F Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
- Piano S Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padova, Padova, Italy.
- Singh V Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
- Bartoletti M Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
- Maiwall R Institute of Liver and Biliary Sciences, New Dehli, India.
- Alessandria C Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
- Fernandez J Liver ICU, Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED); European Foundation of Chronic Liver Failure (EF-Clif), Barcelona.
- Soares EC Gastroenterology Division, Medicine Department, Faculty of Medical Sciences, University of Campinas (UNICAMP). Campinas, São Paulo, Brazil.
- Kim DJ Institute for Liver and Digestive Diseases, Hallym University College of Medicine, Chuncheon, South Korea.
- Kim SE Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang city, Republic of Korea.
- Marino M Liver Unit, Hospital Dr. Carlos B. Udaondo, Buenos Aires, Argentina.
- Vorobioff J Rosario University Medical School, Rosario, Argentina.
- Barea RCR Serviço de Hepatologia do HRMS, Hospital Regional de Mato Grosso Do Sul- HRMS, Campo Grande, Brazil.
- Merli M Gastroenterology and Hepatology Unit, Department of Translational and Precision Medicine, Sapienza Università di Roma, Rome, Italy.
- Elkrief L Service de Transplantation, Service d'Hépato-gastroentérologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
- Vargas V Liver Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain.
- Krag A Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
- Singh SP Department of Gastroenterology, S.C.B. Medical College, Cuttack, India.
- Lesmana LA Digestive Disease and Oncology Centre, Medistra Hospital, Jakarta, Indonesia.
- Toledo C Gastroenterology Unit, Hospital Valdivia, Universidad Austral de Chile, Valdivia, Chile.
- Marciano S Liver Unit and Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- Verhelst X Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium.
- Intagliata N Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA.
- Rabinowich L Liver Unit, Department of Gastroenterology, Tel-Aviv Medical Center and Tel-Aviv University, Tel-Aviv, Israel.
- Colombato L Gastroenterology Department, Buenos Aires British Hospital, Argentine Catholic University (UCA), Buenos Aires, Argentina.
- Kim SG Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
- Gerbes A Department of Medicine II, Liver Centre Munich, University Hospital, LMU Munich, Germany.
- Durand F Hepatology & Liver Intensive Care, Hospital Beaujon, Clichy, University Paris Diderot, Paris, France.
- Roblero JP Departamento de Medicina, Universidad de Chile Campus Centro, Hospital Clínico San Borja Arriarán, Santiago, Chile.
- Bruns T Department of Internal Medicine IV, Jena University Hospital, Jena, Germany; Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany.
- Yoon EL Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul, Republic of Korea.
- Girala M Departamento de Gastroenterología y Endoscopia Digestiva, Hospital de Clínicas, Universidad Nacional de Asunción, Asunción, Paraguay.
- Pyrsopoulos NT Division of Gastroenterology and Hepatology, Rutgers- New Jersey Medical School, University Hospital, Newark, NJ, USA.
- Kim TH Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
- Yim SY Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Hospital, Seoul, Republic of Korea.
- Juanola A Liver ICU, Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED).
- Gadano A Gastroenterology Unit, Hospital Valdivia, Universidad Austral de Chile, Valdivia, Chile.
- Angeli P Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padova, Padova, Italy; European Foundation of Chronic Liver Failure (EF-Clif), Barcelona. Electronic address: pangeli@unipd.it.
- 2020-08-12
Published in:
- Journal of hepatology. - 2020
English
BACKGROUND & AIMS
Bacterial infections can trigger the development of organ failure(s) and acute-on-chronic liver failure (ACLF). Geographic variations in bacteriology and clinical practice could lead to worldwide differences in ACLF epidemiology, phenotypes and associated outcomes. Herein, we aimed to evaluate regional differences in bacterial infection-related ACLF in patients with cirrhosis admitted to hospital.
METHODS
This post hoc analysis included 1,175 patients with decompensated cirrhosis (with bacterial infection on admission or nosocomial infection) from 6 geographic regions worldwide. Clinical, laboratory and microbiological data were collected from the diagnosis of infection. Patients were followed-up for organ failure(s) and ACLF development according to the EASL-CLIF criteria from enrolment to discharge/death.
RESULTS
A total of 333 patients (28%) had ACLF at diagnosis of infection, while 230 patients developed ACLF after diagnosis of infection, resulting in an overall rate of bacterial infection related-ACLF of 48%, with rates differing amongst different geographic regions (38% in Southern Europe vs. 75% in the Indian subcontinent). Bacterial infection related-ACLF more frequently developed in younger patients (55 ± 13 vs. 58 ± 14 years), males (73% vs. 62%), patients with alcohol-related cirrhosis (59% vs. 45%) and those with a higher baseline MELD score (25 ± 11 vs. 16 ± 5) (all p <0.001). Spontaneous bacterial peritonitis, pneumonia or infections caused by extensively drug resistant (XDR) bacteria were more frequently associated with ACLF development. More patients with ACLF had a positive quick sequential organ failure assessment score and septic shock, resulting in a lower infection resolution rate (all p <0.001).
CONCLUSIONS
Bacterial infections, especially with XDR organisms, are associated with the highest risk of ACLF development, accounting for almost half of cases globally. Geographic differences result in variable epidemiology and clinical outcomes.
LAY SUMMARY
Bacterial infections can trigger a sudden deterioration in an otherwise stable cirrhotic patient, a condition known as acute-on-chronic liver failure or ACLF. This study has found that the development of ACLF following bacterial infection occurs most commonly in the Indian subcontinent and less so in Southern Europe. The common infections that can trigger ACLF include infection of the abdominal fluid, known as spontaneous bacterial peritonitis, pneumonia and by bacteria that are resistant to multiple antibiotics. Patients who develop ACLF following a bacterial infection have high death rates and are frequently unable to clear the infection.
Bacterial infections can trigger the development of organ failure(s) and acute-on-chronic liver failure (ACLF). Geographic variations in bacteriology and clinical practice could lead to worldwide differences in ACLF epidemiology, phenotypes and associated outcomes. Herein, we aimed to evaluate regional differences in bacterial infection-related ACLF in patients with cirrhosis admitted to hospital.
METHODS
This post hoc analysis included 1,175 patients with decompensated cirrhosis (with bacterial infection on admission or nosocomial infection) from 6 geographic regions worldwide. Clinical, laboratory and microbiological data were collected from the diagnosis of infection. Patients were followed-up for organ failure(s) and ACLF development according to the EASL-CLIF criteria from enrolment to discharge/death.
RESULTS
A total of 333 patients (28%) had ACLF at diagnosis of infection, while 230 patients developed ACLF after diagnosis of infection, resulting in an overall rate of bacterial infection related-ACLF of 48%, with rates differing amongst different geographic regions (38% in Southern Europe vs. 75% in the Indian subcontinent). Bacterial infection related-ACLF more frequently developed in younger patients (55 ± 13 vs. 58 ± 14 years), males (73% vs. 62%), patients with alcohol-related cirrhosis (59% vs. 45%) and those with a higher baseline MELD score (25 ± 11 vs. 16 ± 5) (all p <0.001). Spontaneous bacterial peritonitis, pneumonia or infections caused by extensively drug resistant (XDR) bacteria were more frequently associated with ACLF development. More patients with ACLF had a positive quick sequential organ failure assessment score and septic shock, resulting in a lower infection resolution rate (all p <0.001).
CONCLUSIONS
Bacterial infections, especially with XDR organisms, are associated with the highest risk of ACLF development, accounting for almost half of cases globally. Geographic differences result in variable epidemiology and clinical outcomes.
LAY SUMMARY
Bacterial infections can trigger a sudden deterioration in an otherwise stable cirrhotic patient, a condition known as acute-on-chronic liver failure or ACLF. This study has found that the development of ACLF following bacterial infection occurs most commonly in the Indian subcontinent and less so in Southern Europe. The common infections that can trigger ACLF include infection of the abdominal fluid, known as spontaneous bacterial peritonitis, pneumonia and by bacteria that are resistant to multiple antibiotics. Patients who develop ACLF following a bacterial infection have high death rates and are frequently unable to clear the infection.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.jhep.2020.07.046
- PMID 32781201
- Persistent URL
- https://folia.unifr.ch/global/documents/170682
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